MSI陽性の子宮体癌では, 腫瘍浸潤CD8陽性リンパ球(TIL)数が高値で, COX-2高発現例ではTIL数は低値で, 多変量解析で, TIL低値, リンパ節転移陽性, 低分化が独立した予後不良因子であった。MSI陽性例にてもCOX-2高発現例は予後不良で, COX-2発現はMSI-高TIL数による腫瘍免疫を抑制する可能性が示唆された。また, 内膜異型増殖症や高分化型子宮体癌の214例に妊孕性温存黄体ホルモン療法を施行し, 再発後に反復治療を施行した症例でも安全に治療を遂行でき, 初回治療後と反復治療後で併せて62例で83回の妊娠を得た。重複癌の発生頻度は7.5%で, 反復治療にて重複癌の発生頻度は上昇しなかった。
The MSI-positive tumors showed significantly higher grades and larger numbers of TILs than MSI-negative tumors. The COX-2-high group showed fewer TILs than COX-2-low group. Multivariate analysis identified a low number of TILs, positive lymph node involvement, and high tumor malignancy grade as factors independently associated with poor prognosis. The number of TILs, which was increased by MSI and decreased by COX-2 expression, was associated with a poorer prognosis in patients with endometrial cancer. We also propose that COX-2 may block MSI-activated TILs in the tumor microenvironment. Regarding fertility-preserving hormonal therapy, we performed hormonal therapy for 214 young patients with atypical endometrial hyperplasia or endometrioid adenocarcinoma G1. We succeeded in 83 pregnancies in 62 patients and showed 7.5% as the frequency of double cancer, and also revealed the safety and effectiveness of repeated MPA therapy after recurrence with the low incidence of double cancer.

研究種目 : 基盤研究(C)(一般)
研究期間 : 2013～2015
課題番号 : 25462612
研究分野 : 医歯薬学